By Francis L. Counselman, M.D., CPE, FACEP
In the August 2013 issue of ACEP News, the various pathways available to current and future emergency medicine residency graduates to achieve Critical Care Medicine (CCM) certification through fellowship training were reviewed. In this issue, the options available to ABEM diplomates who completed a Critical Care Medicine fellowship prior to the establishment of the current pathways will be discussed.
First, there is no “practice only” pathway for Critical Care Medicine. All CCM certification requires successful completion of ACGME-accredited CCM fellowship training, and practice of Critical Care Medicine. Secondly, there is no “grandfather” pathway available through the American Board of Surgery (ABS) for Surgical Critical Care. This decision by ABS was made for internal policy consistency, and there are no exceptions. Finally, like all “grandfather” pathways, there is a time-limited window during which one can apply for certification. Please make yourself aware of these dates.
American Board of Internal
Medicine (ABIM) Critical Care Medicine
For Internal Medicine-Critical Care Medicine (IM-CCM), the “grandfather” pathway requires both the completion of a 24-month CCM fellowship and the practice of Critical Care Medicine. This pathway is scheduled to close on June 30, 2016. For the 24-month CCM fellowship to count, it must meet one of the following criteria: a) an ACGME-accredited IM-CCM fellowship completed prior to September 21, 2011; b) an unaccredited IM-CCM fellowship that subsequently became ACGME-accredited on or before December 31, 1992; or c) an ACGME-accredited fellowship in another critical care specialty (i.e., Surgical CCM, Anesthesiology CCM).
The second component, the practice portion, is a little more complicated. The EM applicant must have met the practice criteria as of the date on which the application is submitted to ABEM. For at least three years, not necessarily contiguous, of the five years prior to submitting the application (including the 12 months immediately prior to submission), the applicant must have met one of the following criteria: a) 40% of post-training clinical practice time in the practice of CCM; or b) 25% of total post-training professional time in the practice of CCM.
Finally, for those ABEM diplomates who completed an ACGME-accredited IM-CCM fellowship in the recent past (i.e., between September 21, 2008, and September 20, 2011) criteria can be met if, during 60% of the time between completing fellowship training and applying for certification, the applicant completed one of the following: a) 40% of post-training clinical practice in the practice of CCM or; b) 25% of total post-training professional time in the practice of CCM. For example, if an applicant completed fellowship training on June 30, 2011, and applied for certification on July 1, 2013, 60% of the time (i.e., 24 months) would be 14.4 months. So, during that 14.4-month period between completion of fellowship training and application submission, the applicant must meet either the 40% or 25% criterion, as described above.
Physicians whose total practice exceeds 40 hours per week may use 40 hours as the denominator for the “40%” or “25%” calculations for either of the above scenarios.
American Board of Anesthesiology (ABA)
Critical Care Medicine (ACCM)
ABEM diplomates seeking certification through the “grandfather” pathway must have completed both an ACGME-accredited ACCM fellowship program (one or two years in length) and the CCM practice component by the time of application submission, and no later than June 30, 2018; this is the final date of the last application period within the grandfather pathway. The ACCM fellowship training must have been started prior to July 1, 2013. In order for the fellowship program to count, it must have been ACGME-accredited at the time of the applicant’s training; it does not count if the fellowship subsequently became accredited.
For the practice component, during the two years immediately preceding the application submission, the applicant must have completed one of the following: a) 40% of post-training clinical practice time in the practice of CCM, or; b) 25% of total post-training professional time in the practice of CCM. For either calculation, if total practice time exceeds 40 hours per week, 40 hours may be used as the denominator for the “40%” or “25%” calculation.
For both the IM-CCM and ACCM eligibility criteria, the “practice of CCM” is strictly defined. An acceptable practice must occur in a designated critical care unit. Caring for critically ill patients in the ED does not count toward the practice component. For more detail on what constitutes the practice of CCM, please visit the ABEM website at www.abem.org
For all CCM subspecialty pathways, the ABEM diplomate must: meet the requirements of the ABEM Maintenance of Certifications (MOC) program at the time of application and throughout the certification process; be in compliance with the ABEM Policy on Medical Licensure; and provide information about someone who can independently verify the physician’s clinical competence in CCM, successful completion of ACGME-accredited CCM fellowship training, and the physician’s practice of CCM. No opportunities for CCM certification existed just two years ago for emergency physicians, but we now have three pathways going forward, including two grandfather pathways. It is a very exciting time for emergency physicians interested in Critical Care Medicine. The opportunities that now exist are the direct result of the hard work, persistence, and energy of many of our colleagues. To all involved, “Thank you!”
Dr. Counselman is Chairman of the Department of Emergency Medicine at Eastern Virginia Medical School, and President-elect of ABEM.
Here’s a link to the first article in this two-part series
Why I will be an Emergency Medicine Physician
By Joey Leary – LECOM- Bradenton Class of 2014
Living in rural Haiti before medical school was my introduction to the field of emergency medicine. Having studied the religion, politics, and culture of the country as an undergraduate anthropology student, my move to the city of Leogane, Haiti in order to volunteer for the University of Notre Dame’s public health initiative to eradicate lymphatic filariasis had context. Further, Dr. Paul Farmer MD, acclaimed anthropologist and physician, had uprooted to this same region years ago. I intended to use my gap-year in a meaningful way which might later give me strength and perspective during my anticipated life as a physician. Today, four years later, it is with this attitude that I reflect upon the 2010 earthquake, and am thankful for my role in one of the most extraordinary tragedies of the century. In the absence of a functioning hospital or any doctors, I was looked to as a physician. The frustration and impotence I felt that day as a first responder has guided me toward a career in emergency medicine.
When the sun came up on Jan 13th, twelve hours after the first earthquake which immediately killed one hundred thousand and would be responsible for the deaths of one hundred and fifty thousand more, I considered how to be most useful. I was exhausted after a sleepless night of walking and hitchhiking the twenty miles from Port au Prince to Leogane, the city which turned out to be closest to the quake’s epicenter. Once back, searching through a partially collapsed Hospital St. Croix looking for friends and trying to call home occupied my time, not sleep. With the destruction of the town’s only hospital, locals began laying the wounded and dead in a field in front of a nursing school, hoping for any sort of expertise. I decided that distributing water and ibuprofen from my first aid kit to a field filled with compound fractures, head injuries, deep lacerations, and amputations, to name a few of the horrific injuries, was the most practical and useful thing for me. When I met an American nurse practitioner, Michelle Sare – founder of Nurses for Nurses International, and was asked to amputate a finger and start splinting arms and legs, my perception amongst the wounded changed. Family members begged me frantically to do something as their loved ones slowly died from internal bleeding, respiratory failure, and renal failure. That day was remarkable in every sense of the word.
Two months of rotations in Memorial Hospital’s level one trauma center in South Bend, Indiana as a third year medical student confirmed my suspicion that emergency care is for me. I couldn’t help but marvel whenever I would see a patient with an injury similar to one I saw in Haiti. The pride that I take in knowing how to treat these acute injuries when confronted a second time is immense. I feel like a wizard when I am able to relieve pain with several well calculated thrusts, a splint, or some well-placed lidocaine. I hope to have more of these skills at my disposal so there will not be a crisis that I am unqualified to respond to.
The most valuable opportunities that have come my way; a chance to volunteer in Haiti, a chance to study dengue fever in the amazon, a chance to work as a camp counselor in Colorado, have always been a result of my enthusiasm and hard work. These qualities, in addition to my unique motivation born out of natural disaster, give me reason to believe that I would make a great emergency physician. Regardless of the matching service’s determination, the moment I step off the plane in Port au Prince this June after graduation, I will be an emergency medicine doctor.
This month’s Annals audio, a look at the national report card on EM, is now posted and available. Highlights:
-The American College of Emergency Physicians has released their comprehensive national and state-by-state report cards on the status of emergency medicine in the United States. We do a brief summary and review.
-The new College clinical policy on procedural sedation and analgesia.
ALIVE – AGAIN
By Bruce D Janiak, MD, FACEP
A 40-something female came into our ED with some confusion, low BP, and tachycardia. EKG and labs were normal, but she continued to deteriorate despite appropriate treatments. The cardiology fellow was with me when she arrested, and despite ACLS protocol, we were unsuccessful in our resuscitative efforts. She was pronounced dead.
As the cardiology fellow and I were discussing her case outside of the room, the monitor began to show a spontaneous rhythm. She regained a pulse and BP and was admitted. Later that day she arrested again and after unsuccessful efforts was pronounced dead (again)!
Then she revisited her Lazerus process and spontaneously recovered.
Some two weeks later she came to the ED to see me saying “Dr Janiak, thanks for your efforts. I could hear you guys talking about me during the whole resuscitative process”
(Yes, this really happened!)
Sorry for delays, sometimes we get all technical…. But the January audio is here! Highlights:
-Cricothyrotomy techniques: a comparison
-Two hand versus one hand BVM ventilation, which one works best?
-Can looking at the RV with bedside ultrasound help diagnose PE?
-Surviving sepsis: an update
-Lit review: can febrile neutropenics go home?
-Late bleeding after crotalid envenomation: how often?
David & Ashley
When something interesting happens in the ED, you tell friends about it.
When a clinical study or great article comes out, you discuss it with other emergency physicians. Why not tell this work-related stuff to 33,000 people who know you best? Say it right here on The Central Line blog. The Central Line is ACEP’s official blog, and to get your blog posted, send your thoughts to this email address.
Once you become a regular, we’ll offer up the keys to the store and let you post directly. Get started!
By Jon Mark Hirshon, MD, MPH, PhD, FACEP
Report Card Task Force Chair
With the release of the 2014 ACEP Report Card on Emergency Medicine, the nation learns how well each state supports emergency medicine and your emergency department.
The nation received an overall grade of D+.
ACEP has produced Report Cards in 2006 and 2009 to evaluate the overall emergency care environment both nationally and on a state by state basis. This is not a report on the emergency care delivered in any specific hospital or by any individual physician, but rather an evaluation of how well the country supports emergency care.
The 2014 Report Card is based on 136 objective measures in five areas:
- Access to Emergency Care (30%)
- Quality & Patient Safety (20%)
- Medical Liability (20%)
- Public Health & Injury Prevention (15%)
- Disaster Preparedness (15%)
It reflects the most recent data available from high-quality sources such as the Centers for Disease Control and Prevention, the National Highway Traffic Safety Administration, the Centers for Medicare & Medicaid Services, and the American Medical Association. Additionally, two surveys were sent to state health officials to gather data for which no reliable, comparable state-by-state sources were available. These data elements were then combined to create the components of the Report Card.
Since 2006, ACEP chapters have used the Report Cards to help with the establishment of new emergency medicine residency programs, support the funding of a statewide trauma system, to help with the enactment of liability protection for federally mandated EMTALA related care, and to increase awareness of emergency medicine issues among state and national lawmakers. We plan to use the 2014 Report Card to educate policymakers and the public about the pivotal role of emergency medicine, help change the conversation from preventing “expensive” emergency visits to protecting access to emergency care, and use communications tools to achieve the national and state recommendations of the Report Card in order to improve the emergency care environment.
To access the most current state by state information, including state and national grades, and to be able to compare the 2014 Report Card with the previous Report Card, please visit: http://www.emreportcard.org/
-Jon Mark Hirshon, MD, MPH, PhD, FACEP
Report Card Task Force Chair
Dr. Hirshon is Board Certified in both Emergency Medicine and Preventive Medicine and has authored approximately 75 articles and chapters on various topics, including the development of public health surveillance systems in emergency departments and placing emergency care on the global health agenda. He has a doctorate in epidemiology and is a federally funded researcher and teacher with specific interest in improving access to acute care and in developing emergency departments as sites for surveillance and hypothesis driven research in public health.
Dr. Jeremy Brown is the director of the newly created Office of Emergency Care Research (OECR) at the National Institutes of Health (NIH). He trained as an emergency physician in Boston, and prior to joining the NIH he worked in the Department of Emergency Medicine at the George Washington University (GW) in Washington, DC. While at GW, he founded the emergency department (ED) HIV screening program and was the recipient of 3 NIH grants that focused on a new therapy for renal colic. He continues to teach at GW on the practice of clinical research, as well as teaching a course on science and religion. He is the author of more than 30 peer-reviewed articles and 3 books, including 2 textbooks of emergency medicine, all published by Oxford University Press. Annals News & Perspective editor Truman J. “TJ” Milling Jr., MD, interviewed Dr. Brown in his Bethesda, MD, office, on the importance of the OECR and how he plans to use his new position to coordinate and grow emergency research within the NIH. His comments have been edited for clarity.
Read the Q and A here
Editor’s Note: Power distributions from an ice storm have impacted business at the American Board of Emergency Medicine, and they have asked ACEP to help spread the word about their special circumstances.
A significant ice storm on Dec. 22 caused power and communication outages with the ABEM headquarters. These disruptions are continuing while the utility companies actively work on restoring dependable service. Please be advised that intermittent disruptions are possible during the next several days. ABEM apologizes for any inconveniences physicians may have encountered in trying to reach its office or website services.
All December 31, 2013, deadlines for completing MOC activities and PQRS MOC Additional Incentive Payment requirements have been extended to January 10, 2014, 11:59 p.m., EST.
The ABEM office will be closed from Dec. 25, 2013, through Jan. 1, 2014.
However, contingent upon the restoration of the power and communication outages the ABEM office is currently experiencing due to the ice storm, staff will be available on December 26, 27, 30, and 31 from 8:30 a.m. to 4:30 p.m. EST to provide assistance with ABEM MOC requirements.
Questions about your ABEM MOC requirements can be sent to MOC@abem.org, or you can call 517.332.4800 for assistance during the times noted.
The University of Florida’s Dr. Donna Carden has been approved for PCORI funding for her research, “An Emergency Department-to-Home Intervention to Improve Quality of Life and Reduce Hospital Use.” Dr. Carden will lead one of 82 research projects approved for PCORI funding to help answer the question: “How can clinicians and the care delivery systems they work in help patients make the best decisions about their health and healthcare.”
Dr. Carden: “The transition from the emergency department (ED) to home can create patient confusion and anxiety and lead to a cycle of repeated, costly and preventable ED visits and hospital admissions, especially for older patients with chronic health problems. There is an urgent need, therefore, for more patient-centered management of patients discharged from the ED. Our research team (patients, caregivers, Area Agency on Aging staff, physicians, health-system managers, researchers) proposed the following question: Compared to usual, post-ED care, can an intervention deployed after an ED visit that links chronically ill patients with community-based social- and medical-support improve quality of life and reduce the need for additional ED visits and unnecessary hospital admissions? We expect the proposed community-based intervention to have a positive impact on patient-reported quality of life and to reduce the likelihood of return ED visits and hospital admissions. The knowledge gained from this work has the potential to contribute to a broader understanding of how post-ED transition interventions can be tailored to reduce healthcare disparities for vulnerable populations, improve healthcare quality and reduce healthcare costs.”
By providing support and funding to pilot-test the proposed, community-based intervention, Dr. Carden said that ACEP and EMF contributed substantially to the success of this PCORI application.